Stroke caused by carotid artery dissection during ablation of atrial arrhythmia

Area of Science:

• Cardiology
• Neurology
• Interventional Electrophysiology

Background:

• Tachyarrhythmia poses a significant risk of poorly tolerated attacks.
• Radiofrequency ablation is a common treatment for cardiac arrhythmias.
• Transseptal puncture is a critical step in cardiac electrophysiology studies.

Purpose of the Study:

• To report a rare neurological complication during radiofrequency ablation for tachyarrhythmia.
• To describe the diagnostic findings and management of carotid artery dissection and thrombosis.
• To emphasize the importance of prompt recognition and treatment of neurological events during invasive cardiac procedures.

Main Methods:

• Electrophysiology study (EPS) with radiofrequency ablation (RF).
• Transseptal puncture procedure.
• Computed tomography angiography (CTA) for vascular assessment.
• Intravenous thrombolytic therapy.

Main Results:

• A 55-year-old woman developed progressive aphasia and right-sided weakness during transseptal puncture.
• CTA revealed left common and internal carotid artery dissection with intraluminal thrombus.
• Intravenous thrombolytic therapy resulted in significant neurological status improvement.

Conclusions:

• Carotid artery dissection is a rare but serious complication of transseptal puncture during EPS.
• Early diagnosis via CTA and prompt thrombolytic therapy are crucial for favorable neurological outcomes.
• This case underscores the need for vigilance regarding potential cerebrovascular events in patients undergoing invasive cardiac procedures.